General Dermatology

Acne

Acne Treatment | Palo Alto | Redwood City | San Mateo Acne is a skin disease that disrupts the smooth surface of the skin and can cause unsightly scarring. Acne can occur on the face, upper back, or upper chest. It can occur very early in adolescence and persist continuously into the late twenties or thirties, or it may occur at any time and last only a few brief months.

Acne occurs more frequently and more severely in some families than in others. Additionally, certain hormones are abundantly produced during adolescence causing excess sebum (oil) production from specific glands of the face, chest, and back. Sebum, debris, and naturally shed skin scales combine to form a hard plug in the opening or along the canal of the oil gland. This hard plug is variously called a comedone, "blackhead", or a "whitehead".

Pores in the skin harbor bacteria which are usually harmless, but can cause inflammation and infection resulting in acne papules if they get trapped and proliferate in a comedone. If the inflammation persists, the comedone or oil-gland ruptures and the inflammation spread to nearby areas and there may be deep-pitted scarring when healing takes place. Scarring may also result from "scratching" at acne papules.

Treatment

Acne can usually be treated with a specific regimen suite to each individual case.

The skin should be thoroughly be cleansed of dirt and debris twice a day and the scalp shampooed frequently.
Loosening of comedones is accomplished by certain medications called “keratolytics” such as Retin-A®, Differin and Tazorac®.
It is generally agreed that certain foods such as chocolate, peanuts, and Coca-Cola® do not play an important role in acne. However, a diet high in vitamin A, found in fresh fruits and vegetables such as broccoli, spinach, and other green leafy vegetables, is probably helpful.
Acne often has periods of improvement and flare-ups. Women will usually notice a flare of acne near their menstrual period. Males will also notice a cyclic variation in the intensity of their acne. Acne can flare during periods of stress (such as final exams or relationship conflicts).
Birth Control Pills (BCPs) can aggravate or alleviate acne depending on their exact composition. Be sure to discuss this with your doctor if you are taking BCPs, or are considering them.
Oily moisturizers and make-ups will aggravate acne. Only oil-free products should be used on the face.
For severe or persistent acne, a medication called Isotretinoin (Accutane®,Sotret® or Amnesteen®) may be used. These medications are related to vitamin-A. They require close monitoring for the four to six month treatment period.

Please call our office at (650) 325-1511 to schedule a consultation.

What is hyperpigmentation?

Hyperpigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits on the skin. Hyperpigmentation can affect any skin color or texture.

What are the types of hyperpigmentation?

Lentigines (also called age or liver spots) are a common form of hyperpigmentation that occurs as a result of sun exposure over many years. These small, darkened spots are usually found on the hands and face or other areas frequently exposed to the sun.
Melasma or Chloasma spots involves larger areas of darkened skin that appear most often as a result of hormonal changes and sun. Pregnancy, for example, can trigger overproduction of melanin that causes the "mask of pregnancy" on the face and darkened skin on the abdomen and other areas. Women who take birth control pills may also develop hyperpigmentation because their bodies undergo the same kind of hormonal changes that occur during pregnancy.
Changes in skin color can result from outside causes. For example, skin diseases such as acne may leave dark spots after the condition clears. Other causes of dark spots are injuries to the skin, including some surgeries.
Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic.

Can areas of hyperpigmentation get worse?

Freckles, age spots, and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun. The already darkened spots may deepen in color as more melanin is produced. Wearing protective clothing and using a sunscreen can minimize the effect of sun exposure.

How is hyperpigmentation treated?

The application of skin lightening products is frequently prescribed to lighten and fade darkened skin patches. These products slow the production of melanin. Prescription bleaches contain twice the amount of hydroquinone, the active ingredient, than over-the-counter skin bleaches. A Q-switched ND-YAG laser can be used to effectively treat small lentigines (age spots), or an intense pulsed light device (IPL) can be used to reduce mottled hyperpigmentation

Please call our office at (650) 325-1511 to schedule a consultation.

Photodynamic Therapy for Actinic Keratoses

What is Photodynamic Therapy or PDT? This technology employs the use of a chemical that is naturally present in our bodies along with certain wavelengths of visible light to affect abnormal skin lesions. It is FDA approved to treat actinic keratoses (AK), precancerous skin lesions that commonly occur after years of sun exposure. It also results in a rejuvenated appearance and can be used instead of liquid nitrogen cryotherapy, which is more painful; or topical 5-flurouracil cream, which needs to be applied daily and results in an unsightly appearance lasting several weeks. PDT has emerging use for acne, rosacea, superficial skin cancer, aging skin, and several other skin conditions, but is not yet FDA approved for these conditions.
How does PDT work? Amino-levulinic acid is a precursor to the production of hemoglobin in the body. This solution, called Levulan®, is applied to the skin and is selectively taken up by abnormal cells and converted to protoporphyrin, which is like hemoglobin without iron in it. This substance is activated by certain wavelengths of light to destroy the abnormal cells.
How is the procedure performed? This is a 2-step process. Our medical assistant or nurse first prepares the skin in the affected area by cleansing and scrubbing. The Levulan® solution is then applied. The solution is allowed to incubate on the skin for a specified period of time, usually one hour. The second step is the activation of the protoporphyrin in the skin by a light source, such as a bank of blue fluorescent tubes, known as the Blue Light or a laser/light source. The light activation takes only several minutes.
What will the procedure feel like? About half of the patients treated feel varying degrees of tingling, burning of stinging during exposure to the fluorescent blue lights, which stops immediately after the light activation ceases.
How effective is it? Studies have show that it has cleared 100% of AKs in about 2/3 of patients after 8 weeks. Many patients will benefit from a second treatment after 8 weeks.
What can be expected after treatment? The skin may be slightly swollen and red, akin to a sunburn appearance followed by flaking and peeling. This is usually fairly mild and usually clears within one week. After the redness and scaling subsides, not only are the majority of AKs resolved, the skin in the treated sites also looks rejuvenated. It is very important to avoid exposure to strong sunlight or bright direct light for 24-48 hours after PDT treatment to prevent an excessive redness reaction. We recommend a wide brim hat and a reflective opaque sunscreen for this period, as well as staying indoors as much as possible
Insurance coverage. PDT treatment for actinic keratoses is covered by Medicare and most health insurance plans. The use of PDT for acne, rosacea, anti-aging effect is not covered at present.

Please call our office at (650) 325-1511 to schedule a consultation.